Hampton's Hump: A Notable Radiographic Finding in a Patient with Infectious Endocarditis.

Infectious endocarditis is a relatively uncommon entity that may present with a variety of clinical scenarios, ranging from a stable patient with nonspecific symptoms to a critically ill patient suffering from embolic disease. We report a case of an otherwise healthy 35-year-old female who presented to the Emergency Department with gradually progressive dyspnea, weight loss, and lower extremity edema. As part of her initial evaluation, a chest radiograph was performed and demonstrated Hampton's Hump, a peripheral wedge-shaped opacity consistent with a possible pulmonary infarct. Further diagnostic investigation in the Emergency Department led to an unanticipated diagnosis of infectious endocarditis. This case serves as an important reminder that nonspecific diagnostic findings need to be appropriately considered in context and is a rare demonstration of Hampton's Hump associated with infectious endocarditis.

Euglycemic Diabetic Ketoacidosis in Concurrent Very Low-carbohydrate Diet and Sodium-glucose Transporter-2 Inhibitor Use: A Case Report.

INTRODUCTION: With the incredibly high incidence of Type 2 Diabetes in the current population of emergency department patients, it is critical for clinicians to understand the possible complications of the treatment of this disease. Medication like canagliflozin are more common to encounter on patient's home medication lists and clinicians should be aware of how these medications, alone or combined with dietary modifications, can result in significant pathology and even mortality if not appropriately treated. CASE REPORT: We report a case of a patient with type II diabetes mellitus who presented with euglycemic diabetic ketoacidosis in the setting of concurrent use of canagliflozin, a sodium-glucose transporter-2 (SGLT-2) inhibitor, and strict adherence to a low-carbohydrate ketogenic diet for weight control. DISCUSSION: Euglycemic ketoacidosis has previously been observed in both diabetic and non-diabetic patients following strict ketogenic diets, as well as in diabetic patients being treated with SGLT-2 inhibitors. CONCLUSION: As more patients choose ketogenic diets for weight control and diabetes management, clinicians should be aware of this potentially life-threatening complication in patients concurrently taking SGLT-2 inhibitors.

Agar ultrasound phantoms for low-cost training without refrigeration.

INTRODUCTION: Ultrasound is a technique that can be utilised to augment procedures to increase their safety and efficacy, but requires that health professionals be trained to use this imaging modality before it can be implemented. With the extremely high cost of manufactured phantoms, homemade alternatives are popular substitutes. Gelatine is commonly used as a matrix to suspend analogues and mimic tissue, but other substrates like ground meat can also be used. Both of these substrates require refrigeration and are subject to spoiling. Our research was designed to evaluate whether agar models would be superior to traditional Gelatine models in their sustainability and whether they would produce ultrasound images adequate for training. METHODS: Agar models of varying formulas (percent agar by weight with certain additives varied) were tested for acceptable fidelity to real tissue, ultrasound image quality, and durability compared to gelatine models and human tissue. RESULTS: A five percent by-mass agar model augmented with small amounts of suspended wheat flour presented as a model that could generate an ultrasound image that remarkably resembled that of real tissue. This agar model does not require refrigeration, is resistant to spoiling and desiccation, mimics tissue texture well, is durable enough to withstand high-volume training, and can be recycled to make new models. CONCLUSION: Agar phantoms are easy to make, do not require refrigeration, and have multiple distinct advantages over gelatine models for ultrasound training in austere conditions.

INTRODUCTION: L'échographie est une technique qui peut être utilisée pour renforcer les procédures et viser à accroître leur sécurité et leur efficacité, mais elle exige que les professionnels de la santé soient formés à l'utilisation de cette modalité d'imagerie avant sa mise en œuvre. Le coût des fantômes industriels étant extrêmement élevé, les alternatives artisanales représentent des substituts répandus. La gélatine est couramment utilisée comme matrice pour mettre en suspension des produits analogues et imiter des tissus, mais d'autres substrats tels que de la viande hachée peut également être utilisés. Ces deux substrats doivent être réfrigérés et sont sujets à une détérioration. Notre étude visait à évaluer si les modèles utilisant l'agar-agar pourraient être supérieurs aux modèles traditionnels en gélatine en termes de durabilité et s'ils pouvaient produire des images échographiques adéquates pour la formation. MÉTHODES: Des modèles utilisant l'agar-agar de formules différentes (variation du pourcentage d'agar-agar par rapport au poids avec certains additifs) ont été testés pour déterminer le degré de fidélité acceptable par rapport au tissu réel, la qualité d'image échographique, et la durabilité par rapport aux modèles de gélatine et aux tissus humains. RÉSULTATS: Un modèle utilisant l'agar-agar à cinq pour cent par masse, renforcé de petites quantités de farine de blé en suspension, s'est avéré capable de générer une image échographique ressemblant de façon remarquable à un tissu réel. Ce modèle utilisant l'agar-agar ne nécessite pas de réfrigération, est résistant à la détérioration et à la dessiccation, imite bien la texture des tissus, est assez durable pour résister à un grand nombre de formations, et peut être recyclé pour fabriquer de nouveaux modèles. CONCLUSION: Les fantômes utilisant l'agar-agar sont faciles à faire, ne nécessitent pas de réfrigération et présentent plusieurs avantages distincts par rapport aux modèles en gélatine pour la formation à l'échographie dans des conditions austères.